Joanna White, RN, BSN, CCRN-CMC
Sarah Gillespie-Heyman, RN, BSN, CCRN

Cardiac Intensive Care Unit, Heart and Vascular Center
Yale-New Haven Hospital

PI: Mary E. Harris, RN
Annette Avallone, RN
Kelly Diorio, RN
Rebecca Elkin, OT
Erin Fa’Alafua, RN
Brenda Fontanez, RN
Betsy Hine, RN
Carla Mapelli, RN
Elisa Mattioli, RN
Kathleen Mazzarella, RN
Margaret Nemetz, PT
Michelle Ransom, RN
Denyse Roden, RN
Prasama Sangkachand, RN
Mentors:
Janet Parkosewich, RN
Marge Funk, RN

Noreen Gorero, RN, BSN
Patient Services Manager
Cardiac Intensive Care Unit
Francine LoRusso, RN, MHA, CCRN, NE-BC
Director, Patient Services
Heart and Vascular Center
Forrester Lee, MD
Dr. Daniel Jacoby, MD
Heart Failure Team Attending Physicians

Pulmonary Artery (PA) Catheter
• Used to assess for type of shock and monitor responses to treatment
• Is a flow-directed balloontipped catheter
• Inserted into vein - floated through right atrium and right ventricle into pulmonary artery

(Cont’d)
• Chamber waveforms viewed on monitor screen during insertion process
Hemodynamic Wave Forms

(Cont’d)
• Traditional care for patients with PA catheters is bedrest leading to:
– Social isolation & depression
– Physical deconditioning
– Higher risk for post-transplant complications
• But – can hemodynamically stable patients be ambulated safely with a PA catheter?
• Important to help stable patients awaiting transplant maintain optimal physical & emotional condition, while ensuring safety

• UNOS 1A Status
• Wait for donor heart
• MD order to ambulate
• PT & OT evaluations
• Ambulate on monitor with RN – each lap around
Cardiac ICU 225 feet
• Patient determines distance & duration of walk
• Is this safe? No evidence to support practice of ambulating patients with PA catheters

• Purpose: To describe the physiologic & emotional responses to ambulation in patients with a PA catheter awaiting heart transplant
• Specific aims to determine:
1. If there were changes in PA catheter position while ambulating (catheter migration)
2.
If ambulation is associated with patients’ feeling of exertion & fatigue
3.
Patients’ perception of how ambulation affects their sense of well-being

Design: Prospective descriptive
Sample: Patients with PA catheter awaiting heart transplant
Setting: Cardiac ICU, HVC, YNHH
Human
Subjects: IRB approved by Yale HRPP

Catheter Migration
Documents measurement on the catheter as it exits the insertion site
Observers PA waveform for changes

(cont’d)
Exertion
6
7
4
5
0.5
1
2
3
8
9
10
Borg Scale
Score Definition
0 Nothing at all
Very, very, weak / light
Very weak / light
Weak / light
Moderate
Somewhat strong / hard
Strong / hard
Very strong / hard
Very, very strong / hard
None
0 1
Fatigue
Fatigue Scale
2 3
Extreme
4

(Cont’d)
• Well-being Scale:
(1=strongly disagree to 5=strongly agree)
Having the opportunity to walk around the unit . . . .
1.
helps me deal with being in the hospital waiting for a transplant
2.
is inconvenient because it interrupts my schedule
3.
is something I look forward to doing
4.
upsets me because it makes me see that I can no longer do what I used to do
5.
is not enjoyable
6.
helps to lift my spirits
7.
helps to keep me in better physical condition
• How does walking make you feel emotionally and physically?

• Obtain written informed consent
• Ambulate patient on portable monitor with RN
• Collect data before, during and after each walk
– Vital signs
– Evidence of change in PA catheter position
– Patient’s perception of exertion (Borg Scale)
– Level of fatigue
• Assess patient’s perception of how walking affects sense of well being (weekly)

(N = 148 Walks by 8 Patients)
Patient #
Age
Gender
# of Walks
(1-10 laps)
1
38
M
2
2
61
M
62
3
53
M
68
4
65
F
7
5
51
M
1
6
65
M
3
7
64
M
4
8
34
M
1
Characteristics
Gender - Male 87.5%
Age (years)
# Walks
Mean (SD)
53.9 ( ± 12.3)
29.4 ± 20.4
Median
57
28.5
Range
34 – 65
1-68

Are there changes in PA catheter position while ambulating?
• 1 of 147 patient walks (0.7%) had change in catheter position (2 cm)
• No catheter-induced arrhythmias
• No changes in PA catheter waveform

10
9
8
7
6
5
4
3
2
1
0
Is ambulation associated with a patient’s feeling of exertion?
Borg Scale
Score Definition
0 Nothing at all
0.5
Very, very, weak / light
1
2
Very weak / light
Weak / light
3
4
Moderate
Somewhat strong
/ hard
Strong / hard
7
8
5
6
Very strong / hard
9
10 Very, very strong
/ hard
0,2 p < .001
0,51 Pre-Walk
Post-Walk
Pre-Walk Post-Walk

Is ambulation associated with a patient’s feeling of fatigue?
2
1
0
4
3
0.28
p < .001
0.58
Pre-Walk Post-Walk
Pre-Walk
Post-Walk

How does ambulation affect a patient’s sense of well-being?
• Well-being Scale: Maximum score = 35
Pt #
2
3
7
Week 1
35
32
27
Week 2
35
33
Week 3
32
32

(Cont’d)
How does walking make you feel emotionally and physically?
• Helps deal with hospitalization, gives patients something to look forward to, and helps lift spirits
• Appreciate opportunity to increase physical activity
• Expressed feelings of improved physical well-being

8 Patients
4 Transplanted 3 LVADs
1 Transplanted 2 Died
1 Died

• In stable patients awaiting heart transplant, ambulating with PA catheter is safe & patients maintained a good sense of well-being
• Patients should be better prepared to undergo transplant surgery & have an easier recovery